Romney says Americans pay more for health care but die sooner

[witness23]

First, I would like to preface this thread with; I am not totally in favor of health care reform. My biggest concern is that people will take advantage of the system, lose their ambition, live off the Government, and not better themselves. With that being said, I would rather give health care to the man or woman that is trying to do the best they can and fall victim to an illness or a injury and cannot afford care or heaven forbid they go bankrupt because of the cost of health care. We already pay for this with the uninsured going to the emergency room and receiving care, I have not had time to look up the numbers but it is a burden on the taxpayers already.

I know this will be hard for some here in this forum but for a second just believe that the Government is not evil and out to dismantle America as we know it. The insurance companies have run amuck with the all mighty dollar being the incentive other than the well-being of the American citizen, wouldn't you agree? Personally, I would rather my taxes stay here at home to help fellow citizens.

PolitiFact | Romney says Americans pay more for health care but die sooner

[Poorboy]

You would think that the cost to the Taxpayers in Emergency Room Visits and the Other Programs would Still Be Cheaper than What is trying to be Rammed Down Our Throats!

[Turtle]

Without question there needs to be health reform in this country. Whether people take advantage of the system and live off the government depends on how the reform gets done. There is actually very little taxpayer money that goes to pay for uninsured emergency room and other health related visits. Some, but not much, at least comparatively speaking. Federal, state, and local governments support care of uninsured patients through public health clinics and through payments to safety net hospitals that care for the poor and uninsured. A recent study (as reported by The Commonwealth Fund) documented that these governmental expenditures total approximately $30.6 billion a year. There are other costs, as well, such as costs to employers in lost productivity, which can be significant, and other consequential costs. The same report showed that approximately $34.5 billion of the costs were born by the health care system itself (hospitals, doctors, etc.), but makes note that the actual costs have not been systematically documented. These numbers seem to be more in line with reality than with the over- or under-inflated numbers you get depending on the agenda of the person presenting them.

As a result of not having insurance, and thus no real primary care physician, many people end up going directly to the emergency room, where costs are significantly higher than if they were treated by in a primary care setting. So in that sense health care reform make a lot of sense. But that's not a quick fix to the problem, as it is a complex one. One, you have hospitals who have to inflate the cost of service in order to pay for those without insurance. Two, hospitals and doctors inflate the cost of service to be precisely the maximum amount that an insurance company will pay, which is in most cases more than the services would and should cost to begin with. Then you've got pharmaceutical companies who inflate the cost of prescription drugs in the US (to near criminal levels) because they have to recoup the cost of R&D somehow, and because in countries where they have universal health care there is a ceiling on what pharma companies can charge for medications, but here in the US the insurance companies will pay for it. It's pretty sad that a prescription in the US that costs $300 a month, will cost you $15 if you fill the same prescription with the same medicine (not counterfeit) in England, Canada, Mexico or Germany.

Health care reform needs to be about a lot of things, and one of them needs to be more than just lip service about controlling costs. In every iteration of the Health Care Bill, controlling costs ends up being who gets to control the money, meaning the government. But a fundamental change of thinking and regulation needs to take place in the free market to actually control costs. Like pharmaceuticals, where they are purely for profit with a shareholder foundation. That needs to stop, not to the point where they are government-controlled not-for-profit organizations, but to the point where everyone gets paid a fair wage, and have enough profit for R&D without having enough profit for obscene executive bonuses and shareholder dividends. You do that and the cost of health care will plummet. Do that with the health care providers, as well, and the costs become manageable. Then you force insurance companies to lower rates in relationship to the actual costs.

In countries where there is universal health care, they cover everybody and do so at a lower cost, and they do it by putting a clamp on pharmaceutical companies, what health care providers can charge for services, on salaries of health care providers. If it's universal, then it shouldn't mean the industry itself can get universally rich, and that's how it is in other countries, but the Bills presented thus far end up allowing the for-profit industry itself to remain at the same, or greater, level of profitability. And the taxpayers will have to pay for every it of it. Everyone will get covered, but it won't be at a lower cost at all. The Congressional Budget Office keeps hammering on that one simple fact, yet everyone else inside the Beltway keeps on ignoring it.

When you look at those statistics that show the US ranked this or that in whatever category you like, here's one to take note of...

Doctor's Average Income
United States $132,300
Germany 91,244
Denmark 50,585
Finland 42,943
Norway 35,356
Sweden 25,768

[layoutshooter]

What are the average costs of malpratice insurance premiums in other countries?

[Turtle]

Far less than here, to be sure (some countries don't allow litigation for malpractice, or have strict caps on them), but those "average incomes" above are after all insurance costs were paid, including malpractice. Since in some countries doctors pays no malpractice insurance at all, removing insurance costs from the incomes is the only way to yield meaningful numbers. (Every now and then the WHO does something right)

[layoutshooter]

How does 132,000 per year compare to other professions here that require equal amounts of education and responsibility? It it too high? Should wages be set? My personal feeling is that they are not all that well paid. Compare it to a ballplayer. How long will it take most of them to pay off loans?

[greg334]

Like pharmaceuticals, where they are purely for profit with a shareholder foundation. That needs to stop, not to the point where they are government-controlled not-for-profit organizations, but to the point where everyone gets paid a fair wage, and have enough profit for R&D without having enough profit for obscene executive bonuses and shareholder dividends. You do that and the cost of health care will plummet.

No it won't help.

What will happen is more of a problem with limitations on drug access and a limitation on discoveries within the pipeline.

Talent costs money and if we go down the path of fairness, we will end up at the garden gate of crap results.

Even though there are obscene bonuses and shareholder dividends, those are mild in comparison to R&D costs that happen because of government regulations. It isn't all about safety when you come down to it but politics.

IF you want to solve part of the pharma problems, it is simple - just do the same thing that needs to be done in the automotive industry Harmonize the regulations between NA, EU and Japan and it will reduce R&D by 40%.

The OTHER part of the problem is very simple too - stop the advertising of drugs to the public and tighten up the regulations between doctors and pharma companies.

One thing that many don't understand is how it really works within the industry, it isn't a cut and dry issue, especially when Canada has one drug for $5 a pill and we get it for $10 a pill, there is a lot that went into that bargain. They hear the defense end and the criticism without seeing what actually makes the system work.

[Turtle]

Greg, yeah, it won't help, if that's all that's done. But like you said, the regulations need to be harmonized. Plus, the regulation of the pharma companies need to be done specifically so that access and the pipeline discoveries won't suffer.

You can count on one hand how many countries allow direct-to-consumer prescription medication advertising. Actually, you can count it on two fingers, and one of those fingers will be gone because New Zealand already has plans in place to eliminate it. Whereas in the United States, studies are being conducted to make the direct-to-consumer advertising more effective.


Layout, you bring the apples, I'll bring the oranges, and we'll compare doctor's salaries to that of unionized professional ball players who's salaries are not even based on performance or responsibility.

[layoutshooter]

I know it is apples and oranges, Turtle, I just find it amazing that some feel that 132,000 is too high for a doctor who they place their lives in their hands. Just misplaced priorities?

How do a doctors start up costs here compare to those other countries?

[Turtle]

I know it is apples and oranges, Turtle, I just find it amazing that some feel that 132,000 is too high for a doctor who they place their lives in their hands. Just misplaced priorities?

I don't know that $132,000 is too high. Those figures are semi-raw, meaning they aren't adjusted for cost of living across the various countries. They're merely converted into US Dollars. Not having to deal with malpractice insurance, or only having to deal with it in a superficial manner, frees up and reduces other costs, like attorney's fees and administration costs. If the salaries of US doctors were to be reduced, it can only happen if the associated collateral costs, and the reasons for those costs, are likewise reduced, like they are in other countries.

How do a doctors start up costs here compare to those other countries?

It costs more to go to college here than in most countries, both undergrad and grad school. Many foreigners are educated here, though, and then return to their home countries to work. The ones educated here and then go back home to work do have better incomes than those who are educated in their home countries or elsewhere, I do know that. But overall, a medical education will likely cost more here than somewhere else. In countries with universal health care, many times the education of doctors and nurses are paid for, at least in part, by the state. India, Germany, France, lots of 'em.

[layoutshooter]

I don't think it is possible to make valid comparisons. The differences between those countries mentioned and ours is so drastic that they cannot be truly compared. We are not the same in even basic ways. We need answers based on OUR laws, OUR Constitution and traditions. Not others. Those are their answers, we need our own.

[Turtle]

I agree. One of the biggest mistakes people make is trying to do something here, because that's the way it's done someplace else. Different countries, different cultures, different people, different economy, different everything.

It's like when we go to another country and impose our morals on them. Same thing.

[layoutshooter]

Different histories, traditions, beliefs and values as well. Their solutions will not work here.

[greg334]

But Turtle, any regulations or controls put on the system outside of dumping government money into the system will really stifle all of it. The joys we have here is these companies don't have to deal with the EU style of business regulations, which is not the ones I am talking about harmonizing.

There is a serious need to harmonize the Discovery, Patent, NDA, SNDA and the AD regulations to ensure they are the same and this will eliminate 40% of the cost in R&D and regulatory requirements. This also means revamping the FDA from the ground up to make sure that there are steps to actually allow NDAs to go through the process faster but not fastrack the NDA.

The other issue that has to do with the FDA but not other countries is the use of phase three drugs and terminal or possible terminal patients. This is where we have a serious issue with the FDA and the Pharma companies and the FDA should not be stopping it.

Whereas in the United States, studies are being conducted to make the direct-to-consumer advertising more effective.

Which studies and who sponsored them?

I wonder if you are referring to the three studies sponsored by Phrma (Pharmaceutical Research and Manufacturers of America) that have been on going?

Or You referring to the two done by the combination of two universities (I think one was Notre Dame and the other was Yale) which was sponsored by Pfizer?

Needless to say, the reason most countries don't allow advertising is what is happening in our medical profession right now.

I won't mention the specifics, but there is a propaganda factor involved in this type of marketing and because of this, the doctor a lot of the times mis-diagnoses the patient. I think you know what I am getting at with the psychology of the ad itself.

As I've seen with some drugs at the rep level, it is a popularity contest among the manufacturers which equates into money. The cost of manufacturing has little to do with the cost to the consumer but marketing is where it is.

By the way, can't quote exact numbers openly but the published numbers for marketing costs is no where near the true mark. One drug company has spent 1.4 times more in marketing than they did in Phase one to three studies and the application but that is the lowest number for the three large players.

[Turtle]

Yes, the ongoing studies by the Pharma, Advamed, among others. Pharma and the Big Four TV networks have been running a study for a couple of years. Pharma is also pushing the FDA hard to allow social media advertising, as well as a paid Google-type medical search engine.

They already know that print advertising, at least so far, is more effective than television and radio advertising, but they also know that if they can worm their way into the conscious and subconscious via Facebook, Twitter, targeted popups and targeted, paid Googlesque search results, they'll be in a position of dramatically altering how medical advertising works. They got slapped down pretty hard last year when they started advertising stuff with a single-word link to the full-risk information, instead of providing it in the same space as the ad. They can't do the full-risk information in space-limiting venues such as social media, and the push now is to let them do it with links, or rather, let them do whatever they please. They are crying foul because print and television rules are being applied to the Internet (PhRMA's Jeffrey Francer called the application of regulations developed for printed materials aimed at healthcare professionals to Internet communications "akin to using standards created for the horse and buggy to regulate automobiles.") The problem, of course, is once the relax the rules, it will be the consumer that is targeted on the Internet, and not just the professionals.